What we know so far about plans for state-backed GP indemnity

By Nick Bostock on the
30 November 2017

Health secretary Jeremy Hunt's announcement at the RCGP conference that the government would develop a state-backed GP indemnity deal offered some hope to a profession that has seen costs soar since the start of this decade. GPonline looks at what we know so far about the plans.

DH guidance published last week acknowledged that rising costs were a 'great source of concern for GPs and impacts negatively on the GP workforce'. It added: 'We are seeking to put in place a more stable and more affordable system of indemnity for general practice.'

How will the state-backed deal work?

The DH has admitted developing a state-backed GP indemnity system will be 'complex', that there are 'many issues still to address' and that plans are at an early stage.

However, officials have confirmed that the scheme is likely to offer cover to GPs through the organisations they work in, rather than individually. DH guidance says: 'We envisage the scheme would provide clinical negligence cover to providers of GP services, through which the activities of individual GPs will be covered.'

This will cover providers on GMS, PMS and APMS contracts, offering indemnity for all practice (or, for example, out-of-hours provider) staff including students or trainees, and could yet be extended to offer cover for prison GPs and other public-sector roles.

Only work carried out as part of the delivery of NHS-contracted primary medical services work would be covered by the DH scheme, meaning GPs will need to take out additional indemnity cover for any non-NHS work they carry out.

GPs also look likely to need cover for legal representation in criminal or GMC investigations and for 'good samaritan' acts. These are also outside the Clinical Negligence Scheme for Trusts - often incorrectly referred to as 'crown indemnity' - that indemnifies doctors working in NHS hospitals.

When will the state scheme begin?

Talks between the DH, medical defence organisations, the RCGP and BMA will begin in November. The DH has said it could take 12 to 18 months to develop the state-backed scheme. A significant element of the talks could involve determining who will run the scheme - will it be administered through existing medical defence organisations, or run directly by the DH or NHS England?

The DH confirmed on 30 November that it had appointed NHS Resolution to administer the state-backed GP indemnity deal. NHS Resolution is an organisation made up of the former NHS Litigation Authority, National Clinical Assessment Services and the Family Health Services Appeals Unit, and already administers the Clinical Negligence Scheme for Trusts - mentioned above.

What will happen in Northern Ireland - and when - is unclear, given that talks to form a power-sharing devolved government appear to have stalled. The UK government has set a deadline in early November for a government to take shape and approve a budget.

Will state intervention solve the indemnity crisis?

Medical defence organisations warn that a state-backed indemnity system will not tackle the overall problem that rising indemnity costs are consuming a growing proportion of the NHS budget. They have called for a cap on the fees lawyers can charge, particularly in cases involving low-value claims, and reform of tort law to bring down costs.

A controversial change to the discount rate announced early this year by the government will also drive up the cost of negligence payouts - with the cost of some claims set to double.

How much money will be needed?

If the estimate that an average GP now pays £8,000 a year for indemnity is correct, the profession's total annual bill comes to around £300m. The BMA says fees rose 50% from 2010 to 2016, and GPonline polls confirm further sharp rises in 2017 for many doctors.

The government has already put £30m a year for 2016/17 and 2017/18 into a GP Indemnity Support Scheme being distributed through practices to ease the cost of indemnity.

But with costs set to rise further before the state-backed scheme is rolled out in 2019 - assuming it isn't delayed - this annual investment will likely have to be quintupled or more to bring GP indemnity costs down to the level they were at when the current decade began.